Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial.

Cardiac catheterisation Cardiac imaging techniques Cardiovascular disease Cigarette smoking Computed tomography angiography

Journal

European radiology

ISSN: 1432-1084

Titre abrégé: Eur Radiol

Pays: Germany

ID NLM: 9114774

Informations de publication

Date de publication:
22 Nov 2023

Historique:

received: 07 06 2023

accepted: 28 08 2023

revised: 24 08 2023

medline: 22 11 2023

pubmed: 22 11 2023

entrez: 22 11 2023

Statut: aheadofprint

Résumé

To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. ClinicalTrials.gov NCT02400229. • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.

Identifiants

DOI: 10.1007/s00330-023-10355-2 PMID: 37991508

pubmed: 37991508

doi: 10.1007/s00330-023-10355-2

pii: 10.1007/s00330-023-10355-2

doi:

Banques de données

ClinicalTrials.gov

['NCT02400229']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

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